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Despite veteran dental surgeon Dr Loh Hong Sai’s impressive resume and illustrious career, his initial foray into dentistry was filled with uncertainty and doubt. Here, he shares his journey as a dentist, the changes in the profession and how he eventually fell in love with his job.

We met Dr Loh Hong Sai in his spotless clinic in City Square Mall. In his down-to-earth, somewhat professorial manner, surrounded by all kinds of modern medical equipment, he told us about how, back in his youth, dentistry had not been his first choice for a career.

“I was a medical fallout,” he said candidly. “In those days, in the 1960s, we were all gunning for medicine. But unfortunately, my results were not that good and I ended up in dentistry with a bursary, which was necessary for me as my parents couldn’t afford to pay for me to get a university education.”

Looking at the success he has achieved in his career, this might seem hard to imagine. He received his bachelor’s degree in dental surgery in 1972 from the University of Singapore (now the National University of Singapore (NUS)) and has practised dentistry for more than 40 years. He served as the second dean of the Faculty of Dentistry at NUS from 1986 to 1995, and was formerly the president of the World Federation for Laser Dentistry and is now the chairman of its Asia-Pacific Division.

For all his accolades, Dr Loh’s foray into dentistry got off to a rocky start. When he entered university, not only was dentistry merely his second choice; it was also not a highly regarded profession at that time, which affected his morale. “At the time, dentistry was very much viewed by the public as a vocation rather than a profession,” he explained. “So my self-esteem when I went into the course was low, and it was difficult for me in the beginning to appreciate what the dental profession was all about.”

Dr Loh recalled that how dentistry was taught during his student days in the late 1960s was very different to how it is taught today. “I would say it was primitive compared to what it is nowadays. The teaching was different, the emphasis was different – technical rather than health-related.” According to Dr Loh, dentistry students nowadays enjoy a fair amount of support in their laboratory work, freeing them up to focus on patient management, but this was not the case back then. During his student days, dentistry students had to carry out a lot of technical background tasks themselves.

He explained how the healthcare profession’s own perspective on dentistry changed over the years. “We now regard the oral environment as being part and parcel of general health. We no longer consider ourselves the tooth, the whole tooth and nothing but the tooth,” he quipped, smiling. “Providing good oral health means helping the patient to achieve good general health as well. It’s part and parcel of the whole self.”

For those of us who are aware of the importance of good oral health, but dread visiting the dentist nonetheless, this perspective probably provides little comfort. Considering old approaches to pain management, however, Dr Loh conceded that the association between seeing the dentist and pain and discomfort is not wholly unwarranted.

“Certainly dentistry is related to pain and people are fearful of [dentists] because of the pain,” Dr Loh acknowledged. “This is ironic, because we’re supposed to relieve pain! But anaesthetics in those days [were administered] through a hypodermic syringe, where you draw up the solution and inject it into the patient and it would obviously be a very frightful experience.” According to him, pain management has come a long way since those days and is now much simpler and less agonising for patients, thanks to the invention of modern dental syringes.

Dr Loh described cases where patients claimed to experience pain in their teeth, but upon examination, no physical problem with their teeth was found. These patients were actually experiencing psychosomatic conditions, where stress or other psychological factors manifested as physical pain.

“A lot of patients do come to us with stress – not arising from physical pain, but from their everyday life. They tell us they are experiencing dental pain, but essentially they are suffering emotional pain,” he explained. “You can tell by the absence of dental origin – they might say there is pain in their jaw, but then we don’t find any issues with their teeth.” He has seen this in people of all age groups, from young adults to the middle-aged and to the elderly.

Dr Loh pointed out that in this way, the dental profession is actually quite broad in scope; what might seem to the layman as a branch of medical care involving just teeth is actually cross-disciplinary and internally complex.

“There are probably as many specialities in dentistry as there are in medicine, save for gynaecology,” he explained. “Whatever subspecialties there are in medicine tend to be mirrored in dentistry, say oncology – there is oral oncology too. There should be no reason why dentistry should have different diseases from other parts of the body, right?”

“In fact, undergraduate dental students probably spend 60 percent of their time studying medicine, before they start studying dentistry. You need to learn the basic physiology, physics and chemistry of the body first.”

Dr Loh explaining the structure of a human tooth, using a model. Photo by Chew Hui Lin

To Dr Loh, however, misconceptions about the nature of dentists’ work continue to abound, and the dental profession still struggles with an intractable image problem. For example, many believe that dentists’ work simply entails extracting teeth and filling cavities, when it actually involves so much more.

“We need to make people aware that the dental profession is more than just pulling and filling teeth,” he said. “Dentistry actually provides a whole array of management for oral and dental diseases of the head and neck – gum problems, children’s problems, problems faced by the elderly. The perception of dentistry by the public needs to improve.”

Dr Loh would be ecstatic if people incorporated visits to the dentist into their regular routines, much like going to the hairdresser’s. “To get people to see us on a regular basis, like how you might go to get your hair done three times a year – oh, we [dentists] wish they would do the same!”

Turning the conversation towards his patients, Dr Loh noted that the demographic of his patient base has changed over the years. Compared to the early years of his practice, he now sees more elderly patients due to Singapore’s ageing population, as well as patients from other countries in the region such as Malaysia, Thailand, and Indonesia, which he attributes to Singapore’s reputation for excellent healthcare. In addition, while he believes oral health in Singapore has improved overall due to better health education, he has also noticed more people seeking aesthetic procedures for their teeth.

Over the course of his career, he has earned the trust and respect of numerous patients who now regard him as their go-to dentist – for instance, one of his patients has been seeing him since childhood.

“He had a cleft palate and we treated him, corrected all the deformities together with the medical doctors,” he recalled. “Seeing him become an adult with his own family, raising his own child to adulthood, was a very rewarding experience. It’s a kind of lifelong management and I’m very happy to say that I’ve seen at least two patients’ sons from infancy to adulthood.”

Dr Loh has developed his own pre-surgery ritual over the years, which he performs before carrying out a procedure. “Some might play music and all. For me, I run through the steps of the operation in my head when I take a bath in the morning, which helps me gain confidence. I say a prayer for myself, that all will go well. And I reassure my patient to make sure that they are confident, too, and that we will go through the surgery together.”

All in all, Dr Loh is happy with how his career has turned out, especially since he hadn’t planned to train as a dentist initially. As he spoke about his career, we could not help but feel that fate had intervened to direct him toward the path he was meant to take. When asked if he would choose a different career given the chance, his answer was firm.

“Seriously, no. I really enjoy my career. It’s been a perfect match for me. I’ve had opportunities to teach, research, and do clinical work as well,” he said. “Dentistry is rewarding because it’s very much a personal, one-to-one service, and the reward of doing something nice for the patient and making them comfortable is something that I truly treasure. I don’t think there’s anything else I would do besides what I’ve done so far.”